Predicting Intravenous Immunoglobulin Resistance Among North American Children Hospitalized With Kawasaki Disease

Jasdip Singh; Arthur Chang; Nicholas M Fusco; Mark Hicar

doi:10.5863/1551-6776-27.7.669

Predicting Intravenous Immunoglobulin Resistance Among North American Children Hospitalized With Kawasaki Disease

J Pediatr Pharmacol Ther. 2022;27(7):669-676. doi: 10.5863/1551-6776-27.7.669. Epub 2022 Sep 26.

Authors

Jasdip Singh¹, Arthur Chang², Nicholas M Fusco¹, Mark Hicar²

Affiliations

¹ Department of Pharmacy Practice (JS, NF), University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY.
² Department of Pediatrics (AC, MH), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.

Abstract

Objective: The Kobayashi score (KS) is the most widely used tool for predicting intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD). The KS has shown good sensitivity (86%) and specificity (68%) in Japanese children; however, its use is limited outside of Japan. No models accurately predict IVIG resistance of children with KD in the United States. We sought to develop and test a novel scoring system to predict IVIG resistance in hospitalized children with KD.

Methods: A retrospective chart review was conducted of all children diagnosed with KD from January 2000 to December 2015. Subjects were divided into 2 groups: IVIG susceptible or resistant. Variables that differed between the groups were identified and used to create a "new score" to predict resistance to IVIG. The new score was then compared with the KS and performance characteristics were determined.

Results: A total of 208 subjects were reviewed. White blood cell count, neutrophil percentage, age, and serum albumin were used in the new score with equal weighting. Overall, the new score achieved improved sensitivity (54% vs 26%) and similar specificity (69% vs 74%) compared with the KS in predicting IVIG resistance in hospitalized children diagnosed with KD.

Conclusions: Predicting IVIG resistance in children diagnosed with KD remains challenging. The KS has low sensitivity in predicting IVIG resistance in children with KD in the United States. The new score resulted in improved sensitivity, but many children with true IVIG resistance may be missed. Further research is needed to improve IVIG resistance prediction.

Keywords: Kawasaki disease; Kobayashi score; coronary artery aneurysm; intravenous immunoglobulin resistance.

Grants and funding

Disclosures. The authors declare no financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.